Provider Demographics
NPI:1992136683
Name:KOUHKAN, MEHRNAZ (DPM)
Entity type:Individual
Prefix:
First Name:MEHRNAZ
Middle Name:
Last Name:KOUHKAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11690 MONTANA AVE
Mailing Address - Street 2:APT 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4671
Mailing Address - Country:US
Mailing Address - Phone:310-838-6872
Mailing Address - Fax:
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:STE 204
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2455
Practice Address - Country:US
Practice Address - Phone:310-347-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3152213ES0103X
PASC006423213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery